taylormomto6

Thank You, but I think I have to go through Crowne Bariatric in Corona, Ca. because this is the one my medical group has a contract with. I'm in the 2nd month of my 6 month diet and am really struggling because I've just quit smoking as well. Thanks! Cindy T

They won't require another 6 month diet. This one will carry over, as long as you attend all sessions. Now my medical group also requires another 3 month class after the 6 month one, but they've been upfront on that. I don't have HealthNet, but my sister in law does. We live in the Bakersfield area and she has a different medical group than I do. She was just approved after one appeal without a 6 month diet, they never even mentioned it. If I had known hers doesn't require the 6 months, I'd have gone with them to begin with, my PCP belongs to both groups, but I think Blue Shield does require the 6 months anyway, so I figure I'll complete it and if they deny me even after appeals, I'll switch then :biggrin: Good Luck to you, Cindy T

This is my Medical Group that requires this stuff. I spoke to my PCP and he said they can't deny me for not losing that much weight. I'm thinking I'll attend all the classes and if they deny me at the end of all this, I'll appeal to the insurance company. I have Blue Shield HMO and they do not list these things in their requirements. I have the complete support of my PCP as well as my gynocologist, so I'll get letters from them as well. If I have to I'll go to Obesity Law and inlist their help. Cindy T

Well, I attended my first class yesterday and found out that after the 6 month diet, I have to attend a 3 month pre WLS class as well. In addition to attending, in the WLS class you are required to lose 20% of your weight before they will approve surgery. Absolutely no surgery is performed without the 20% loss, no matter how long it takes you. That is on top of whatever weight you lose in the 6 month diet class. When I asked them if losing weight in both of those classes would make someone ineligible for WLS, they said that would depend on your starting weight and how much was lost, but yes, it could make you ineligible! GRRRR...these people are very sneaky....they do set a very moderate goal of 4 lbs a month in the 6 month diet class, but thats still 24 lbs gone. Then an additional 20%, for me would be another 48 lbs gone for a total of 72 lbs., which would put in the 190s and probably ineligible since I don't have diabetes, sleep apnea or severe heart problems. Unless a person weighs 300 lbs or more, I just don't see how you can approved after all these requirements. Why don't they just say you have to have a BMI of over 50 to qualify, that would at least save a lot of people the trouble. So, now I'm at a loss as to how to get these classes in, lose weight, but not too much....geez! The only "good" news was that when I used the online calculators for my BMI, it was 43.7, but they had me hold this thing to measure BMI and it was over 47. Now thats not normally good news, but at least that gives me a bit more wiggle room. Very Confused, Cindy T __._,_.___

I understand your frustration! You are doing the right thing by changing medical groups. I would be sure to choose a new PCP that is supportive of WLS. Be sure and go to every appointment for your 6 month diet. Don't give them any excuses to deny. Good Luck!! Cindy T

Thank You mesaucy. At least I know where my surgery will be LOL. They are giving me the runaround already. Got a letter yesterday requesting I call "for an appointment"...when I did she said I had been put on a waiting list...no, I had already been signed up. Anyway, I go in today for measurements and I think she signed me up for the class...who knows. I'm also out of town, 35 miles, so this is going to be pricey. I'll update later after my appointment. Cindy T

OK, well at least I finally got approval to join the medical groups (Bakersfield Family Medical Group) Weight Management program. It doesn't begin until July 17 though. These people are seriosly trying to get us to lose weight without the surgery. The first 9 weeks is a weekly class on nutrition and exercise. All food and exercise must be logged in a journal and they do measurements and weeekly weigh ins. Then it moves to every 2 weeks where I'll meet with the Health Education Centers rep for the remainder of the 6 months. At anytime that the consider I'm not doing so well, they refer me to the nurse:mellow: I guess for a beating lol. I'm guessing during this 6 months I should not let my BMI drop below 40? Then, I believe they will put me through their WLS teaching class as well. At this time they'll do the psyc eval. After that I'm guessing will be the medical tests. Then I guess they'll approve or deny. mesaucy- since you have BS Ca HMO, do you know a surgeon that takes this insurance? Actually, I think they even have to be contracted with the medical group. They really are trying to trip you up it seems. Making it difficult so they can find an excuse to deny. Well, there's my update. I'll add more after I start the Weight Management class. Cindy T

Thanks peg, yeah, I'm not at all upset about the 6 month diet. I understood that was going to be a requirement and I agree, it'll be informative. I'm most interested to know if others that have HMOs have had to go through their medical groups like this. If they accept me into the "teaching program" does that mean they will approve me as long as I jump through all the hoops? I called them today and they said they received the referral a week ago and it should be processed today, so I'm thinking approval for an educational class should not be that difficult if entry into the classes wasn't a type of preapproval for the surgery (of course that would be dependent on all the hoops being cleared). I also still do not know where the surgery is done. Blue Shield lists no bariatric surgeons that accept HMOs within 250 miles, so I'm not sure where they send us. Of course there are several nearby that accepts Blue Shield PPOs, but I just can't squeeze out another 200 month to change it right now. Anyway, I guess I'll find out soon enough. Cindy T Maybe I'm just wishful thinking:embaressed_smile:

No one has had to go through their medical group like this? No comments?? Cindy T

I have BS HMO and just filled out the "weight loss surgery education criteria checklist" with my PCP to see if they will accept me into their program. If they accept me, I'm to join their 6 month weight loss class and simultaniously attend wls education classes at the medical group. Apparently the educators will then submit a psychological profile on me to qualify me for surgery. I must attend all sessions, comply with all assignments and exercises as determined by the counselor, show that I will be able to practice necessary post op lifestyle changes and not have any significant psychological problems. I looked at the website of my medical group and the next weight loss class begins in July. Not real thrilled about waiting until then, but thats the way it goes. So the best I'm looking at is a surgery date after Jan 09. Anyone have to go through their medical group like this? Cindy T

Thanks Shalee!! For me, I have an HMO, so going out of network is not an option for me. If you have BS PPO, try Bariatric Solutions at San Juaquin Hospital. Happy-did you check with them? Cindy T

Oh Gosh Happy Loser, I go to Porterville often! I play bingo at the casino at least once a month. I used to go a couple times a week, but finances have changed, so I can't go as often. Bariatric Solutions takes BS PPO. They work through San Juaquin Hospital. I think they have a GREAT program and that would be much closer like you said. Let me know how you like it:biggrin2: Cindy T

I bet your diabetes in gone!! Keep me informed. There are several docs in the area. I bet you can find one thats in network. Weocome to the area!!! Cindy T

Shalee, thank you so much for responding! So nice to someone from my area! And congrats on your success!! I tried to go to the Mercy seminar, but I asked her if they took my insurance and they don't. Wouldn't do me much good to attend if there's no chance I'll have the surgery through their program. I saw my PCP today and he's referring me to the Medical Groups seminar at Bakersfield Family MC. The good news is he has oredered a bunch of testing since I've not been under a doctors care. Chest X ray, ultrasound on my arteries, EMG, EKG and blood work. Hopefully I'll have some of these tests will also satisfy some of the bariatric testing. The PCP said that insurance will deny first and tell us everything they will need to approve and we will work from there. I specifically asked about my lack of a 5 year medical history and he didn't seem concerned. So, at least I feel like I've began the process. Cindy T

A little update...I called my Medical Group and to ask where they send people for bariatric surgery seminars and they said my PCP must submit an authorization and I then I can attend an informational meeting at their Health Center. I see my PCP this morning at 8:30 and will be asking for just that:wink2: Cindy T